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South Dakota rates for HCPCS L6250

Above elbow, molded double wall socket, internal locking elbow, forearm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,254.09 / $3,254.09 / $3,254.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,964.10 / $3,182.18 / $3,254.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,561.34 / $2,561.34 / $4,177.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,153.71 / $4,503.75 / $5,629.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,753.48 / $4,006.55 / $16,910.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,298.16 / $2,167.54 / $4,286.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,473.53 / $4,177.51 / $6,185.16
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,421.39 / $4,236.30 / $7,983.14
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,718.05 / $3,182.18 / $3,782.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,259.01 / $2,143.94 / $2,856.22
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,721.79 / $3,721.79 / $3,721.79